Tuesday, 17 May 2011

Balancing roles in the new NHS

The NHS continues to be a political football. All political parties agree on the need for some kind of change to manage rising expectations, new and expensive treatments and an ageing population. But what to do?

I've certainly no special wisdom but I do have concerns over the current proposals. I'm not alone in this and there is a lot of activity by David Cameron and his government recognising the disquiet of many doctors.

I've worked in the NHS for 33 years (and was training for 5 years before that) so I must confess to getting somewhat annoyed by any politician who has only recent experience of it who then pontificates about how it should be run. But again I acknowledge that wisdom is in short supply. So I'm relived when I get some clarity on my convictions.

A recent article in the British Medical Jourmal by Mark Sheehan has helped. It's title, 'It's unethical for GPs to be commissioners'. As he notes it seems that the government (and probably the Daily Mail) seem to be mainly attachment 'too much management', thus,

The government wants to liberate the English National Health Service. By this they seem to mean to liberate the NHS from managers. The idea is that managing can be done by those who are already doing another job—general practitioners.

But as he goes on to point out, this new role has great capacity for compromising the traditional role of the GP (and which am prod to be associated with) as patient advocate.

When we think of the role of doctors, we include some reference to them focusing on what is best for us. When we disagree with our doctor, we disagree about what is best for us: the doctor-patient relationship is a negotiation of the differences between the doctor’s view of my best interests and my view of my best interests. Trust and confidentiality are precisely built on the understanding that my doctor has my interests at the forefront of his or her mind. If the GP is tasked with resource allocation, there is now an additional dimension to the decision: what is best for others.

Decisions about prioritising resources have to be made, but, given the role of doctors and the importance of trust, they should not be made by GPs. Like anyone else working in the NHS, GPs should be aware of these decisions and their difficulty. But, if anything, the GP is, and ought to be, the patient’s advocate in this process.

I just don't know how one can honestly maintain the two roles of 'balancing the budget' (a decision for our politicians informed by various other groups representing the general public) and being a patient advocate.

As he concludes,

The current system of resource allocation is emerging as an increasingly functional process. There may well be issues of overmanagement to be resolved, but the solution to these problems is evolutionary, rather than a revolutionary overhaul that disbands the system in favour of general practice consortiums. The role of the GP as patient advocate is a crucial one and should not be compromised by giving GPs the additional role of resource allocation managers for the NHS.

I really hope that the government 'listening' exercise will read, mark, learn and inwardly digest such helpful voices as Mark Sheehan.